What it is and isn’t about

As we count down to the annual ADA gathering our attention isn’t so much what we will see in San Francisco but what we won’t see. Anticipating what we will see is pretty easy as there will be new toys for that ever-growing toy chest. There will be reams of data on new drugs for the medicine cabinet and there will be a plethora of way cool whiz bangs apps. Yet what we won’t see or likely hear is anything about one of the biggest if not the biggest problems in diabetes; patient access.

Recently we’ve had the good fortune to attend some patient events, events where we could talk with real patients. Unlike the ADA conference which is filled with executives, sales reps, clinicians and investors these events provided access to the most important link in the diabetes chain, the patient. Patients who must live with diabetes every day of their lives. Patients who for the most part want one thing very badly and it’s not a new toy or drug.

What these patients want most of all is access to the toys and drugs that are currently available. Sure they would love it if the toys they played with where better. Just as they would like it if the drugs they took worked even better. But more often than not these patients are managing their diabetes just fine with the toys they have and the drugs they use, when they have access to them.

Far too often at these events we hear one thing over and over again, how the patients’ health insurance coverage dictates how they manage their diabetes. Something we also hear consistently from the physicians who treat these patients. Listen it’s bad enough these people must worry about their diabetes, but it adds insult to injury that they must also navigate the complex world of reimbursement. A world which does not have set standards where the rules vary and vary greatly from one provider to the next.

While everyone likes to dump on the insurance companies, we do understand their side of the ledger. For all the talk we hear about outcomes the fact is the way things are structured today insurance companies could care less about better outcomes. That likely will change in the future but that is not the way it is today. Right now for private insurers the mantra is to manage their diabetic patient population as cheaply as possible.

There is no incentive for these payors to have liberal reimbursement policies. Payors know that these patients won’t be with them very long. They play a game of Russian Roulette hoping that the many costly complications that come from poorly controlled diabetes does not happen when the patient is part of their plan. The goal is simple manage them as cheaply as possible while they have them and hope that costly complications kick in after they leave the plan likely when they are on Medicare.

This is one reason we continue to push for a new paradigm for when the old way doesn’t work there are two choices; continue to the same worn out path or move in a new direction. Unfortunately many of the newcomers to diabetes those high-tech cash rich companies who are making the deep dive into diabetes are making the same mistakes as the old guard. Many of them are taking old ideas putting them in a shiny new box and thinking the results will be different. The irony here is that with their huge hordes of cash and continued ability to generate even more cash from their core businesses they could if they wanted to make a huge difference in diabetes. As we have said since these companies began their dive into the diabetes pool, they do not need diabetes to generate a profit from day one they can take their time and do it right.

Like it or not diabetes is a business where scale is critical, scale drives efficiencies which then drives profit. Unlike traditional diabetes companies or franchises who must play the hand they are dealt as diabetes is their core business, these techies can play a completely different game. Yet for reasons they only understand they have chosen to play the same game as the traditional companies.

Will this change? Will these companies wake up smell the Starbucks and realize that maybe just maybe they shouldn’t play the same game? Only time will tell. We hope so not because they would make gobs of money rather because if they did it would be the patient who ultimately wins.